Can Ultrasound rapidly confirm the correct position of endotracheal tube? A cross sectional study

Introduction: Endotracheal intubation is an essential technique in airway management. It may be associated with potentially serious complications. Although, there is still little experience in the use of ultrasound in endotracheal intubation, many studies in adults seem to suggest that it is as reliable and fast as conventional methods. Aim: to assess the usefulness of bedside ultrasonography compared to capnography and chest X-ray in confirmation of correct endotracheal tube position in ICU patients. Methods: cross-sectional study was conducted in RICU, Assiut university Hospital, Egypt. All 50 patients were subjected immediately after intubation to:Capnography, neck and chest ultrasound, Chest x-ray;to confirm correct ET intubation. All methods were compared with capnography as a gold standard method. Results: Correct endotracheal intubation was confirmed by the presence of 3 successive waves in the Capnography, achieved in 96% of cases (endotracheal tube) and in 4% cases the tube was falsely placed in the esophagus. Direct localization of intubation by neck US had 97.7% sensitivity,100% specificity to confirm the correct intubation with area under the curve was 0.99 and P<0.001. Indirect localization of the tube by chest U/S had 93.7% sensitivity,100% specificity with area under the curve was 0.96 and P<0.001. Although localization of the tube by chest X-ray has 97.8% sensitivity;it took too long time (29236.44±768.27 sec). There was insignificant difference between capnography and neck ultrasonography in detection of endotracheal tube position. Conclusion: In areas where capnography is not available; US because of its high accuracy and safety profile can be used as a primary verification method.